School Age Program

CCL 355 Program Director’s Annual Report SAP form is to be submitted to the Kansas Department of Health and Environment (KDHE)(additional documentation is required).

View School and Child Care Immunization Information.

Application Packet Forms

  1. CCL 303 Closure Notification (PDF)
  2. CCL 351 SAP Application (PDF)
  3. CCL 351a Instructions SAP (PDF)
  4. CCL 351b Application Checklist SAP (PDF)
  5. CCL 355 Program Director's Annual Report SAP (PDF)
  6. CCL 362 New High Risk Activity Form (PDF)
  7. CCL 402 Orientation Checklist for School Age Program (PDF)
  8. CCL 002 Background and Registry Check (PDF)
  9. CCL 002 Background and Registry Check Spanish (PDF)
  10. CCL 002a SAP Affiliate Roles (PDF)
  11. CCL 002a SAP Affiliate Roles Spanish (PDF)
  12. CCL 028a Critical Incident Report (PDF)
  13. Critical Incident Reporting FAQs (PDF)
  14. Corrective Action Plan Provider Instructions (PDF)
  15. Corrective Action Plan Template (PDF)

Supplemental Forms in Application Packet

  1. CCL 002 Background and Registry Check (PDF)
  2. CCL 002 Background and Registry Check Spanish (PDF)
  3. CCL 002a SAP Affiliate Roles (PDF)
  4. CCL 002a SAP Affiliate Roles Spanish(PDF)
  5. CCL 010 Authorization for Emergency Medical Care (PDF)
  6. CCL 010 Authorization for Emergency Medical Care Spanish (PDF)
  7. CCL 026 Short-Term Medication Authorization (PDF)
  8. CCL 026 Short-Term Medication Authorization Spanish (PDF)
  9. CCL 027 Long-Term Medication Authorization (PDF)
  10. CCL 027 Long-Term Medication Authorization Spanish (PDF)
  11. CCL 357 Health Status for 14 years and Older (PDF)
  12. CCL 358 Child Health History (PDF)
  13. CCL 359 Authorization for Self-Administration (PDF)
  14. CCL.034 Off Premises Permission Individual (PDF)
  15. CCL.035 Off Premises Permission Group Trips (PDF)
  16. CCL.037 Guidelines for Exclusion of children who are ill (PDF)
  17. CCL 356 Application for Program Director Approval (PDF)
  18. CCL 356 Application for Program Director Approval Spanish (PDF)
  19. CCL 203 School Age Programs Self-Audit Survey Tool (PDF)

Supplemental Forms not in Application Packet

  1. CCL 031 Request for Exception (PDF)
  2. CCL 031 Request for Exception Spanish (PDF)
  3. CCL 032 Request for Amendment (PDF)
  4. CCL 032 Request for Amendment Spanish (PDF)
  5. CCL 209 Notification of Program Director Change (PDF)
  6. CCL 360 Inquiry Regarding Licensure SAP (PDF)

Informational Documents

  1. Child Care Initial and Annual Surveys (PDF)
  2. Child Care Initial and Annual Surveys Spanish (PDF)
  3. Child Care Complaint Survey Information (PDF)
  4. Child Care Complaint Survey Information Spanish (PDF)
  5. CCL 006 Reporting Suspected Abuse and Neglect (PDF)
  6. CCL 006 Reporting Suspected Abuse and Neglect Spanish (PDF)
  7. CCL 008 Licensing of Child Care (PDF)
  8. CCL 036 Selecting Child Care Guide for Parents (PDF)
  9. CCL.037 Guidelines for Exclusion of children who are ill (PDF)